Healthcare Provider Details

I. General information

NPI: 1356798664
Provider Name (Legal Business Name): DEBBIE TEODORESCU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4741
  • Fax: 401-444-4445
Mailing address:
  • Phone: 401-444-4741
  • Fax: 401-444-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP03603
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number278280
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: